A Commentary on the “Duration of Oral Antibiotics Administration for Cetuximab-Induced Acneiform Eruption”

Acneiform eruption is a devastating cutaneous side effect of cetuximab, a monoclonal antibody used to treat a variety of cancers. Despite its effectiveness, many patients avoid or discontinue it after experiencing its dermatological side effects as it negatively impacts their quality of life (QoL). This displays the immense need for multidisciplinary collaboration to prevent and treat cetuximab-induced acneiform eruption (CIAE). Prevention methods include, but are not limited to, education, skin care routines, and prophylactic drugs. The following measures reduce the likelihood of developing CIAE and decrease its severity, making it easier to treat if it were to occur. Ongoing research on the treatment of CIAE continues. Of these treatments, oral tetracyclines and systemic corticosteroids have been shown to be the most effective by far. This commentary aims to evaluate the study by Park et al. [Dermatology. 2021;237(3):457–63], further elaborate on prevention and treatment measures of CIAE, and highlight the implications of CIAE on a patient’s QoL.

Severe and delayed-onset acneiform eruptions as an adverse reaction to regorafenib

Regorafenib is an oral multikinase inhibitor targeting several tyrosine kinase receptors including BRAF and epidermal growth factor receptor (EGFR), and is approved as a third-line treatment for metastatic gastrointestinal stromal tumor (GIST). While acneiform eruptions have been observed in patients receiving other BRAF and EGFR inhibitors, the commonly reported adverse reactions to regorafenib are fatigue and palmar-plantar erythrodysesthesia. Herein, we report, to the best of our knowledge, the first case who presented with a severe acneiform eruption 24 months after beginning regorafenib for the treatment of GIST. A 61-year-old woman developed GIST with multiple liver metastases, and she was treated with imatinib and sunitinib. However, these therapies were discontinued, and regorafenib was administered. Twenty-four months after beginning regorafenib, she developed an acneiform eruption on her back. Histopathologic analysis of a skin biopsy from the back revealed neutrophilic suppurative folliculitis. Therefore, she postponed regorafenib administration for 2 months and was treated with topical application of clindamycin phosphate hydrate, which was effective. Consistent with reported evidence that the presence of acneiform eruption and the efficacy of EGFR inhibitors are positively associated, regorafenib had good anticancer activity in our patient. Ultimately, we found that although regorafenib-associated skin toxicities usually appear within 1 month of treatment, patients potentially can present with delayed-onset acneiform eruptions even 24 months later.

Topical Corticosteroid Therapy for Facial Acneiform Eruption due to EGFR Inhibitors in Metastatic Colorectal Cancer Patients: A Randomized Controlled Trial Comparing Starting with a Very Strong or a Weak Topical Corticosteroid (FAEISS Study, NCCH1512, Colorectal Part)

Background: Althoughpre-emptive therapy with oral tetracycline, moisturizer, sunscreen and topical corticosteroid isuseful for preventing acneiform eruption (AfE) due to epidermal growth factor receptor (EGFR) inhibitors, no studies have examinedthe efficacy of topical corticosteroids themselves, or investigated the optimal strength of the corticosteroid for treating facial AfE (FAfE).Patients and Methods: Screened patients with RAS wild-typecolorectal cancerstarted pre-emptive therapy with oral minocycline and moisturizeron initiation of cetuximab or panitumumab therapy. Patients who developed grade 1 or 2 FAfEwere randomly allocated to two groups:a ranking-down (RD) group,started with a very strong corticosteroid, and serially ranked down every 2 weeks unless FAfE exacerbated, and a ranking-up (RU) group, started with a weak corticosteroid and serially ranked up at exacerbation. FAfE grade, patient quality of life, and adverse events (AEs) with topical corticosteroid were evaluated every 2 weeks.The primary endpoint was the total number of times grade 2 or higher FAfEidentified in thecentral review of the 8-weektreatment period.Results: No significant differences in total numbers of grade 2 or higher FAfE and inAEs caused by topical corticosteroids were observedbetweengroups during the 8-week. Incidence of grade 2 or higher FAfEwas tended to lower inthe RD group during the first 2 weeks.Conclusion: Considering long-term care of FAfE, the RU regimen appears suitableand should be considered the standard treatment for FAfEdue to EGFR inhibitor therapy. Trial registration: UMIN Clinical Trials Registry (UMIN000024113)

A Cross-sectional Study of Acneiform Eruptions at a Tertiary Center

Background: Acneiform eruptions represent 1% of all drug-induced skin reactions following exposure to drugs such as hormones, vitamins, halogens, anti-tubercular drugs, neuropsychotherapeutic drugs, immunomodulating agents, and other miscellaneous drugs. Aim: The aim of the study was to identify the topical, inhalational, intralesional, and systemic drugs causing acneiform eruptions. Materials and Methods A total of 46 patients presenting with acneiform eruptions were studied with detailed drug history. Conclusions: Acneiform eruption is a relatively common and often misdiagnosed entity. Systemic steroids are the most common cause of acneiform eruption.

Pattern of Drug Utilisation in the Management of Hyperpigmentary Disorders in a Tertiary Care Hospital- An Observational Study

Introduction: Hyperpigmentary disorders, a common skin disorder affecting individuals with darker skin especially Asians, Blacks, Hispanics and American Indians, has a great impact on patient’s Quality of Life (QOL) with physical distress and psychological impact, and studies have shown that there is an improvement in QOL after treatment. The topical medications include sunscreens, demelanising agents, immunomodulators like tacrolimus, retinoids and Glucocorticoids (GCs). Systemic therapy includes GCs and antioxidants. Physical therapy includes chemical peels, microderma abrasion, Laser and light therapies and mesotherapy. Aim: To determine the pattern of drug use in hyperpigmentary disorders, to assess the tolerability of therapy and to analyse the effect of hyperpigmentary disorders of skin to the prescribed medications on the QOL before and after treatment. Materials and Methods: This was a prospective, observational study conducted on 102 newly diagnosed and untreated participants with hyperpigmentary disorders, who attended Dermatology Outpatient Department of a tertiary care hospital, Bangalore, India. The pattern of drug therapy, route of administration and Adverse Events (AEs) to the therapy was documented and analysed using descriptive statistics. The QOL using Dermatology Life Quality Index (DLQI) was assessed before and after treatment using Analysis of Variance (ANOVA). The patients were monitored every 30 days for three months to study the appropriateness, changing trends in prescription pattern, tolerability and QOL. Results: A total of 102 participants were enrolled for the study. The mean age was 33.71±10.68 years in males and 34.07±10.27 years in females. The different classes of drugs used were demelanising agents, sunscreens, antifibrinolytics, calcineurin inhibitors, keratolytics, glucocorticoids. The number ranged from 2-4 drugs per participant with a mean of 3.01±1.01. A significant improvement in the QOL was observed after treatment (p-value <0.01). Most of the AEs were self limiting except a few (acneiform eruption, rosacea) which were topical GCs induced. Conclusion: The individualised prescription pattern by treating physician was in concurrence with the standard line of therapy as they fulfilled the desired objectives. Hydroquinone (HQ), tranexamic acid and triple formula were the mainstay of treatment. The QOL improved after treatment.